EMBARGO UNTIL 00 00 GMT on Monday 26
EMBARGO UNTIL 00. 00 GMT on Monday 26 February (Sunday, 16. 00 H in Los Angeles) Implications for HIV prevention and child health of diarrhoea outbreak in Botswana l Peggy Henderson l Department of Child and Adolescent Health and Development, WHO l CROI, February 2007
Relative risk of infectious disease mortality among non-breastfed infants Relative risk 5. 8 4. 1 2. 6 1. 8 Age (months) WHO Collaborative Study Team, Lancet, 2000 1. 4
No Difference in combined 18 -Month mortality + HIV infection between Formula and Breastfed Infants (Thior et al. , JAMA, 2006) % HIV-Infected or Dead FF: 33 infected, 62 deaths BF: 53 infected, 48 deaths p=0. 08 p=0. 86 p=0. 60
The Dilemma for HIV-positive women: Balancing risks Mortality HIV transmission Infectious diseases through breastfeeding Malnutrition from not breastfeeding
To be a better option than exclusive breastfeeding, replacement feeding has to be AFASS l Acceptable l Feasible l Affordable l Sustainable AND l Safe for the mother and baby Assessment also needs to include: l Health service accessibility l Counselling and support available
Countries need to ensure compliance with International Code of Marketing of Breast-milk Substitutes l Adopted by WHA, 1981, subsequent resolutions expand clarify l 84 countries reported measures to implement Code (2006) l Ensures proper marketing of l Botswana breast-milk substitutes – Enacted Code into law – Implementation and l HIV-negative and status monitoring begun unknown: National – Violations of Code still implementation protects found (2005) breastfeeding and prevents "spillover"
Emerging evidence on HIV and Infant Feeding l Exclusive breastfeeding associated with decreased risk of HIV transmission compared to non-exclusive breastfeeding l Early cessation of breastfeeding associated with diarrhoea and mortality in HIV-exposed children Breastfeeding of HIV-infected infants beyond 6 months associated with improved survival compared to stopping breastfeeding
HIV and Infant Feeding Technical Consultation Geneva, October 25 -27, 2006 CONSENSUS STATEMENT l The most appropriate infant feeding option for an HIV-infected mother should continue to depend on her individual circumstances, including her health status and the local situation, but should take greater consideration of the health services available and the counselling and support she is likely to receive. l Exclusive breastfeeding is recommended for HIV-infected women for the first 6 months of life unless replacement feeding is acceptable, feasible, affordable, sustainable and safe for them and their infants before that time. l When replacement feeding is acceptable, feasible, affordable, sustainable and safe, avoidance of all breastfeeding by HIV-infected women is recommended.
http: //www. who. int/child-adolescent-health/NUTRITION/infant. htm
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